The
report finds that there are still significant opportunities to improve
efficiency within the health service, for example by improving procurement and
changing clinical practice. However, with more than a quarter of trusts already
in deficit, the report warns that a financial crisis is now inevitable by
2015/16 and could arrive sooner than this, with damaging consequences for
patient care.

The
report highlights the progress made in improving efficiency in the face of the
unprecedented slowdown in NHS funding since 2010. But it warns that the main
ways of reducing costs - holding down salaries, reducing the prices paid to
hospitals and cutting management costs - have now almost been
exhausted.

Analysis conducted for the report shows that the NHS
budget is under huge pressure. This will be exacerbated by the introduction of
the Better Care Fund in 2015/16, which will divert a further £1.8 billion
in NHS funding to support joint working with social care. In the long term, the
report finds that on current projections, NHS spending as a proportion of GDP
will fall to 6 per cent by 2021, its lowest level since
2003.

Crucially, the report argues that new funding should not
be used to disguise the need for change by propping up unsustainable services.
Instead it should be used for two distinct purposes:

to
establish a health and social care transformation fund to meet the costs of
service changes and invest in developing new models of care outside
hospitals

to
make emergency funding available to provide temporary support for otherwise
sound NHS organisations experiencing difficulties as a result of the
unprecedented pressures on their budgets.

The
report, which is partly based on detailed research carried out in six NHS
trusts, also identifies four key ways in which efficiency can be
increased:

a
stronger national focus on collating and disseminating good practice in
improving efficiency

more emphasis on encouraging doctors, nurses and other
frontline staff to identify and lead changes in clinical
practice

stronger leadership at a regional level to plan and
implement changes to services across large geographical
areas

a
more sophisticated approach to the way in which hospitals are paid and NHS
organisations are incentivised to improve efficiency.

John Appleby, Chief Economist at The King's Fund and lead author
of the report, said: ‘There is still scope to improve efficiency in the
health service, and efforts to release savings should be re-doubled. However,
it is now a question of when, not if, the NHS runs out of money. Without
significant additional funding, this will lead to rising waiting times, cuts in
staff and deteriorating quality of care. It is essential that politicians from
all parties are honest about the scale of the financial pressures facing the
NHS and initiate a public debate about the long-term sustainability of the
health and social care system before, not after, the general
election.'

The King's Fund is an independent charity working to
improve health and health care in England. We help to shape policy and practice
through research and analysis; develop individuals, teams and organisations;
promote understanding of the health and social care system; and bring people
together to learn, share knowledge and debate. Our vision is that the best
possible care is available to all.